Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study
Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study
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DOI：
10.1186/1471-2407-12-216
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发表时间：
2012-06-06
期刊：
影响因子：
3.8
通讯作者：
Venturini, Marco
中科院分区：
文献类型：
--
作者：
Clavarezza, Matteo;Mustacchi, Giorgio;Venturini, Marco
背景资料：国际治疗指南建议行政辅助化疗在早期乳腺癌的基础上，临床，预后和预测parameters.Methods：一项观察性研究（NEMESI）进行了63意大利肿瘤中心的早期乳腺癌患者。记录年龄、体力状态、伴随疾病、绝经状态、组织学、肿瘤尺寸（pT）、腋窝淋巴结状态（pN）、分级（G）、雌激素和孕激素受体（ER和PgR）、增殖指数（ki 67或MIB-1）、人表皮生长因子受体2（HER 2）和辅助治疗类型。这项研究的主要目的是确定参数影响的决定，规定辅助化疗和化疗的类型。结果：1894例患者的数据。69.0%绝经后，67.0% pT 1，22.3% pTmic/pT 1a/pT 1 B，61.0% pN 0，48.7%管腔A，18.1%管腔B，16.1% HER 2阳性，8.7%三阴性，8.4%未知。57.8%接受了辅助化疗：38.1%为Luminal A，67.3%为Luminal B，88.2%为HER 2阳性，97.6%为三阴性。给药方案：9.1% CMF样，48.8%蒽环类，38.4%蒽环类+紫杉烷类，3.7%紫杉烷类单药。增加的pT/pN和轻微的HER 2阳性与蒽环类加紫杉烷类处方相关。37.3%接受化疗的患者接受了次优方案（CMF-like或AC/EC或FEC-75），即使在HER 2阳性和三阴性疾病中也是如此（分别为36.5%和34.0%）。pT、pN和HER 2是选择化疗类型的主要决定因素。至少三分之一的HER 2阳性和三阴性患者采用了次优的化疗方案。
Background: International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters.Methods: An observational study (NEMESI) was conducted in 63 Italian oncology centres in patients with early breast cancer. Age, performance status, concomitant disease, menopausal status, histology, tumor dimension (pT), axillary lymph node status (pN), grading (G), estrogen and progesterone receptor (ER and PgR), proliferative index (ki67 or MIB-1), human epidermal growth factor receptor 2 (HER2) and type of adjuvant treatment were recorded. The primary objective of the study was to define parameters influencing the decision to prescribe adjuvant chemotherapy and the type of chemotherapy.Results: Data for 1894 patients were available. 69.0% postmenopausal, 67.0% pT1, 22.3% pTmic/pT1a/pT1b, 61.0% pN0, 48.7% luminal A, 18.1% luminal B, 16.1% HER2 positive, 8.7% triple negative, 8.4% unknown. 57.8% received adjuvant chemotherapy: 38.1% of luminal A, 67.3% luminal B, 88.2% HER2-positive, 97.6% triple negative. Regimens administered: 9.1% CMF-like, 48.8% anthracyclines, 38.4% anthracyclines plus taxanes, 3.7% taxanes alone. Increasing pT/pN and, marginally, HER2-positive were associated with the prescription of anthracyclines plus taxanes. Suboptimal schedules (CMF-like or AC/EC or FEC-75) were prescribed in 37.3% receiving chemotherapy, even in HER2-positive and triple negative disease (36.5% and 34.0%, respectively).Conclusions: This study showed an overprescription of adjuvant chemotherapy for early breast cancer, particularly referred to luminal A. pT, pN and, marginally, HER2 were the principal determinants for the choice of chemotherapy type. Suboptimal chemotherapy regimens were adopted in at least one third of HER2-positve and triple negative.